Brain tissue perfusion during pulmonary endarterectomy - The impact of controlled regional cooling

BackgroundOpen pulmonary endarterectomy (PEA) carries a high risk of neurological complications due to cerebral hypoperfusion and ischemia-reperfusion injury. Systemic cooling during extracorporeal circulation may not sufficiently reduce brain temperature. Combining systemic and targeted head-neck cooling may enhance neuroprotection.MethodsIn this single-center retrospective study, 22 PEA patients were analyzed. All underwent deep systemic hypothermia (22-24°C). Eleven received adjunctive external head cooling using the Aurora head-neck device, and eleven used ice packs (Control). Cerebral oxygenation was monitored with near-infrared spectroscopy (NIRS), and neuron-specific enolase (NSE) levels were measured preoperatively and postoperatively.ResultsCerebral desaturation events (rSO₂ < 40%) occurred in 22.2% of Aurora patients versus 77.8% of Controls (p = 0.030). Postoperative NSE levels were lower in the Aurora group; however, the difference did not reach statistical significance (p = 0.087).ConclusionDual-modality cooling combining extracorporeal hypothermia and targeted head-neck cooling improved intraoperative cerebral oxygenation and were associated with lower postoperative NSE levels; however, due to the limited sample size, no definitive conclusions regarding neuronal injury can be drawn.